After our last failed IUI + injectables cycle, MM and I agreed to take a couple of cycles off due to summer travel plans we had which we feared might interfere with monitoring, etc.
Today is CD 7 of the third cycle after that most recent failed medicated cycle, so we have been discussing the utility of doing additional IUI + injectables cycles. Our insurance pays for a portion of up to six IUIs, lifetime, and we have used four. So in theory, we have two left which would be partially covered.
I'm having a bit of a hard time deciding whether it's worthwhile to do additional IUIs. This cycle is our 30th cycle TTC. In each and every cycle, we have had intercourse during the appropriate "fertile" window. So far as I know, I ovulated during each one of those cycles. (I know for sure that I ovulated during the six cycles when I was monitored and our RE told me I can reasonably conclude that I ovulated during most of the others due to cycle length, + OPKs, etc.)
In 29 cycles of TTC, we have had a single BFP which ended in a chemical pregnancy at about 5 weeks. (That was about this time last year.) That pregnancy was the result of a break cycle. . . . a true break cycle, when I wasn't even using OPKs or charting or making sure we did "the deed" at the right time. Other than that one very early miscarriage, whether medicated/monitored or not, I have never been pregnant.
I suppose one of the pros of doing additional IUI + injectables cycles is that they will slightly increase our odds of conception. Our RE has estimated that we have a 5% chance of natural conception each cycle and a 10-15% chance with IUI + injectables, depending upon the number of follicles I produce. If his estimates are correct, we are doubling or tripling our chances of success with this type of treatment.
On the other hand, I have done four IUIs so far, three of those after using injectables with Clomid (one Clomid alone), as well as two cycles of timed intercourse after ovarian stimulation, and have absolutely zero to show for them. I have read a few research studies that show that IUIs are not very effective in women around age 40; I'm currently 39 and will be 40 in March.
In my mind, I'm not sure that IUIs are even indicated for us. MM's sperm count is normal (actually, well above the threshold for all our IUIs). His motility and morphology are also normal. I have no reason to believe there is any problem with my cervical mucus making it difficult for his sperm to reach the eggs; in fact, our RE told us that the fact that we did conceive naturally once makes it extremely likely that there is no barrier to conception caused by my cervical mucus or anatomy.
Another potential pro is the feeling that we are doing something to increase our chances. Although it is not impossible that we could conceive on our own, it seems highly unlikely. And even if we decide to go the DE IVF route, it will be months and months--perhaps more than a year--before we can afford to do it. But on the other hand, I don't know that it will really make us feel good to know that we are doing something when what we are doing is something that we doubt will work.
Also, while insurance pays for a portion of these IUI + injectables cycles, it does not pay for all of it. Each cycle will cost us several hundred dollars of our money. . . . money that might be better put toward saving for DE IVF (or something else, who knows what) down the road. I'm not fond of throwing good money after bad, and the fact that IUIs have not worked so far makes me inclined to think that they won't work for us, period.
Assuming our RE is correct, the main issue preventing us from conceiving a pregnancy that can continue past 5 weeks is poor egg quality. Neither IUIs nor ovarian stimulation will remedy that problem.
So that's where we're at. MM has said he will defer to me in making the decision, since I am the one who will have to take the drugs and do the monitoring if we decide to do more IUI + injectables cycles.
Thoughts? What would you do?
(Bear in mind that IVF with my own eggs is out of the question for us, for all the reasons I set forth here.)